Working in the community

Before Christmas I was working in Community which I do love. I particularly like it when I see women before and after the birth of their baby, or to see women on their first day home and then to see them when they are being discharged. In both situations, I have witnessed many changes in the women. I have witnessed the nervous woman become a confident mother, and I have witnessed the confident professional become very unsure and lost when faced with a tiny helpless baby. Babies are certainly unpredictable and it doesn't matter how many books you read before they are born, you simply can't be fully prepared.

One of the most common questions to be asked as a Midwife is "is this normal?" - this might be during pregnancy or after the birth but it gets asked a lot. 99% of the time (a guess, I haven't sat and worked out a statistic)  I would say yes, that it is perfectly normal. Babies are born with their own personalities and all we can do is respond to their needs to the best of our abilities. In the early days this often means trying to guess at what they need...mentally going through the checklist - hungry? nappy needs changing? too hot or too cold? tired? It's all guess work really until you can begin to learn your baby's cues.

Frequently new mothers ask about how to get their baby to sleep in the moses basket/crib/cot...anywhere rather than lying on Mum. Don't worry I did the same myself, in fact I think I spent the first 2 years of my eldest's life wondering and worrying about how to get her to sleep anywhere but near or on me - she had to be in contact in some way, whether lying on me or just having a hand on me. Generally I advise new mothers to cuddle their babies...shocking I know...but the baby has spent 9 months inside Mum, able to hear her heart beating as a constant sound, and never before having experienced hunger, temperature, gravity and yet we expect babies to suddenly sleep by themselves. Birth is a shock to them and they need reassurance and comfort. I also advise trying putting something that smells of Mum in the crib, warming the crib with a hot water bottle (ensuring to remove it before baby goes in) so it's not suddenly cold on their back, giving baby to Dad to settle for sleep, a slumber bear if they can afford one but what works for one baby won't work for another, and sometimes what works one night won't work the next, and sometimes it feels that nothing works at all. It can simply be a case of give it time...it certainly was the case with my eldest daughter. My younger daughter was far easier - she'd sleep anywhere! I certainly don't believe it was anything I did that made her more likely to sleep, just that she was born with that kind of personality. So give it time, cuddle your baby, try these things by all means but I promise that at some point, your baby will be able to go to sleep by themselves. I have been on the receiving end of such advice and at the time it felt like useless advice, the tiredness was relentless, and that even one more night was one night too many but I hope it brings comfort to know that yes this is normal for many babies.


I seem to have wandered into the realms of sleepless nights and generic advice but it is something that new mums ask about so often that I feel it's worth discussion. Certainly I feel that the lack of sleep I endured when my children were younger has prepared me well for night shifts as a midwife. As a breastfeeding mother helper, helping to run the group, the women that came along would frequently ask for help with sleep and their babies. We live in a society where "sleeping through the night" appears to be main focus, the ultimate goal, particularly in the early days and then with some desperation as time goes by. However if were simply to accept that babies wake in the night for an indefinite period of time, is it not easier to cope with? That actually the norm is not for babies to sleep through the night, but for them to wake regularly to feed and that at times they will sleep for longer and other times they will wake more frequently, such as during growth spurts which again are normal. I know that I found it far easier to deal with my second child's nightly wakings because I was prepared for it. I was still exhausted at times, and I still complained about it but I didn't waste energy trying to fight it or find an answer to it. I tried things to see if it helped but I didn't worry if it didn't, I just recognised that she wasn't ready yet. However I did have the advantage of not working at that time, I wasn't yet a student either. My eldest spent mornings at nursery so I used that time to catch up a bit and rest.  I think we have a tendancy in this country to try and push ourselves back to normal as soon as possible and actually we'd do well to stop and learn about our babies, spend time with them, allow time to recover from the birth properly...focus on what's important...not on having a show home, or getting out and about as quickly as possible, make use of friends and family to help out if you can. This is of course all very idealistic and I do realise that but I can dream, at least when I'm allowed to sleep that is. At the very least I think this is useful advice for those very early days....stop, rest, recover and cuddle your baby.

Photos courtesy of Marie Donn Photography

Baby Loss Awareness Week

Today is the beginning of Baby Loss Awareness Week and tonight many women all over the world will be lighting candles to join in the Wave of Light, myself included. Will you join in?

Some time ago my friend Marie offered to write a guest post for me about baby loss and I didn't hesitate to accept. As often happens, life got busy and in the way, so it took some time to organise. However, both of us agreed that this week was the perfect timing and I think you'll agree that Marie offers some valuable advice to both students and qualified midwives alike. Thank you Marie x

How has this past week been for you? Has it been a normal week? Perhaps you were working long shifts in your local hospital, or you were on placement in the community. Maybe you were studying, or if you’re lucky you’ve been having a well-earned break.

I don’t know what all of you were doing, but I do know that about 120 of you last week were supporting someone who had lost a child to stillbirth or neonatal loss. And I know that 120 of you will be faced with doing this next week.

And then the same the week after.

And then the one after that.

Because as you may or may not already know, on average 17 babies older than 24 weeks’ gestation die every day in the UK, before or shortly after birth. As a midwife you absolutely will be dealing with these situations one day, repeatedly in most cases.

This week wasn’t a particularly out of the ordinary week, although you may well have seen more publicity about baby loss awareness recently. The campaign, for which I’m not a spokesperson may I say, brings together four UK charities that if you’re not aware of you could do worse than to have a read about: The Miscarriage Association, The Ectopic Pregnancy Trust, Antenatal Results and Choices, and Sands, the Stillbirth and neonatal death association.

Each of them publish guidelines and leaflets for health professionals as well as for those who are affected directly and indirectly by pregnancy and neonatal loss. Each of them offer support both for those affected and for you as healthcare professionals. I’ll even make it easy for you and link to some here, here and here.

Why do I care? Why should you care? And who am I anyway?

I’m Marie. I’m a 30-something mum from Essex, who wears either a personnel or photographer job hat depending on what day you find me – I’m certainly not in healthcare. I like cats and chocolate, but I try not to mix the two. I drive a little too fast sometimes, I bite my nails when I’m tired or bored, and I wish that Gok Wan made clothes for the shorter fatter people in society. My son died two years ago, before birth. I’m one of the women you might have met, or will meet one day.

So, when it’s ‘your’ week, what kind of midwife will you be for any of those 120 women, just like me?

Will you be the midwife who told me to ‘know my place’ in my first lost pregnancy, when I sat on the bed before she’d asked me to? Will you be the midwife who, in an open reception full of other pregnant women, asked me what SANDs did and what had happened, and didn’t know what the SANDs sticker on my notes meant? Will you be the midwife who assured me I would not be placed next to a labouring woman after my son died, but then couldn’t understand why I was traumatised when they did exactly that? Will you be the midwife who drew the curtains around my bed in HDU rather than have to watch me cry? Will you be the midwife who, after the scan to confirm my son had died, told me all about her children and large family? Will you be the midwife who dismissed my tears and told me off for raising my blood pressure without offering support to me?

And if you’re not a midwife, but you’re another healthcare professional, will you be the one who ignored my requests for pain medication and told me to keep the noise down so I didn’t upset others when I was labouring with my late miscarriage? Will you be the one who chatted about Christmas at the end of my bed instead of getting me the bedpan I had asked for? Will you be the one who refused to admit me, bleeding heavily and screaming, to ER until my husband had filled out forms?

Will you be the amazing midwife sonographer who supported me through multiple pregnancy losses and successful pregnancies, made time to talk in the waiting room, minimised the delay and wait for scans, and provided tissues when it was all too much? Will you be the comforting midwife who always made time to listen and explain when I didn’t understand the printout from the DAU during my exhausting last pregnancy and just COULDN’T leave the hospital before I knew whether my son was okay? Will you be the caring midwife who understood why I was distraught that I had been assigned to be seen by a junior instead of my consultant at a key stage in my subsequent pregnancy, and arranged a better appointment for me? Will you be the home-visit midwife who held me while I cried when she visited me to check my blood pressure after my son died, and made special trips to come and see me, taking her time to sign me off until she was sure that I could get through a day? Will you be the labour midwife who stayed by my side during my entire 7 hour labour with the boy who would never cry, open his eyes, or smile, helped my husband dress him, and took his precious pictures and handprints? Will you be one of the midwives who visited my other son in NICU when he arrived early and I was in recovery, taking personal delight in sharing a happy end to my story?

This week, as a midwife or a healthcare professional looking after pregnant women you cannot choose not to deal with these situations, in the same way that I and my fellow women have no choice but to endure them. You can, however, choose how to deal with them, and how you are remembered afterwards. What will you choose?

For some stats on Baby Loss watch this.

For more information click here.

Nightmares

One more week on placement, one more assignment result to come in and almost one year's training completed. The last year certainly seems to have flown by all of a sudden, although it didn't feel that fast whilst it was happening.....definitely felt slow when I was writing assignments.

This past week I have been spending my time with a Health Visitor and some of the other staff that work in the Children's Centre. The staff are lovely and have tried hard to fill my week with a number of different activities so that I get to see plenty. However it has been an unusually quiet week and I haven't seen much at all. It's also quite unusual for me to have nothing to do, as it's an observational placement. I've found it really difficult to sit back and not do anything and well I'm not very good at keeping my mouth shut.

Over my time at various groups with my own children, and time spent on parenting forums, I had heard a variety of stories, both good and bad, about Health Visitors. Stories of poor advice, outdated advice, fantastic support, reassurance, pushiness, unrealistic advice amongst other things. I could probably write a book of stories I have heard about health visitors. Personally I have only had the misfortune of one poor experience with a Health Visitor, all the rest have been fantastic. So whilst this doesn't really relate to my Midwifery training, I thought I'd share my experience. I'd been to see her about my daughter's nightmares, desperate for any advice I could get and she told me it was a bad habit. My jaw literally dropped and I was almost speechless. My husband "encouraged" me out of the room fairly quickly as he could sense my temper was rising. My daughter is now 5 and still suffers from nightmares, although she is far better than she was. At the time I approached the Health Visitor, she was having 3-4 nightmares a night and it would take 30-50 minutes to calm her down each time. She'd wake shaking with fear, sweating and her eyes would dart around the room looking for whatever horror it was that had scared her. Yet this was a "habit"? A year later, some educational psychologists happened to visit the school and I took the opportunity to ask their opinion on nightmares. They were very reassuring and calm, and explained how it was quite normal at her age, and that I should expect it to pass within a couple of months. They then asked me how long she'd suffered with them? My reply was "at least 2 years" and it was their turn to have their jaws drop.

I've always been fairly confident of the reason behind her nightmares - she has a very active imagination. She could make up stories and worlds of her own from a very young age. She would carry around her imaginary friends of spiders and monsters....and it was my feeling that in actual fact, it was spiders and monsters that she was afraid of.  At 5, she still has one nightmare a night most nights....very occasionally she'll sleep through the whole night. We've tried keeping a diary, reducing her cheese intake, giving her a nightlight and a variety of other things suggested to us. She's always had a good bedtime routine of bath or quiet time, story and then bed. Nothing has really made any difference to whether or not she has a nightmare. These days I may not be able to completely stop the nightmares but when she does wake from the one that she has, I "give" to her a good dream, which somehow seems to work. I live in hope that one day she will outgrow them but for now I will just be there for her to comfort her, and never will I consider it a habit she has to break.

I guess my experience with this particular Health Visitor has taught me,  to always think about what I am saying, that if I don't know the answer to something, that it is ok to say so and that making assumptions is bad enough without voicing them as well.